The terms disc degeneration, degenerative disc disease and spondylosis are often used to describe the same problem. These are very common findings. By the age of fifty, 85 percent of the population will show evidence of disc degeneration or spondylosis. Of course, the vast majority of these cases are without symptoms. It is only the patients who develop symptoms, chiefly low back pain, that need treatment.
Aging and injury are common causes of lumbar spondylosis and disc degeneration. Disc degeneration is seen as a loss of hydration of the disc material. This loss of water in the disc leads to a decrease in the normal height of the disc. The loss of height, in turn, may put increased stress on the facet joints of the spine causing them to degenerate and in the process increase in size. These changes may eventually cause pressure on the nerve roots. This may result in sciatic-type pain.
The most common symptom of disc degeneration and lumbar spondylosis is no symptom at all. The vast majority of cases are asymptomatic. When symptoms are present, the most common is midline low back pain with or without radiation to the hips. Aching pain in the buttocks and or the backs of the thighs may be seen with walking.
As always, a careful history and physical examination are the first steps in diagnosis. In most cases, the neurological examination will be normal. Sometimes, there will be decreased motion of the spine due to pain. MRI examination will usually demonstrate the degenerative changes. This may be all that is needed for diagnosis. In some cases, further examination with lumbar myelogram and post-myelogram CT scanning and/or discography may be recommended.
Most symptomatic cases of lumbar spondylosis/disc degeneration resolve with conservative (non-surgical) management. The absolute best treatment has yet to be determined. A short course, two days or so, of bed rest seems to be helpful. Medications such as non-steroidal anti-inflammatory drugs and muscle relaxants are often prescribed. In some cases, steroids either taken orally or injected into the epidural space may be used. Physical therapy and a home exercise program may be helpful.
If conservative management fails to afford adequate relief after a reasonable amount of time (usually at least three months), then surgery may be recommended. In most instances, the surgery will involve a fusion of some sort. The fusion may be performed from the back or through the abdomen. The abdominal approach may be done either through a regular incision or endoscopically. The specific type of surgery will be determined by the surgeon based on the patients symptoms and the result of the various diagnostic studies.